AdventHealth Pre Access Financial Clearance Specialist Infusion Center FT Days in Maitland, Florida
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Pre-Access Infusion Financial Clearance Specialist - AdventHealth Maitland
Top Reasons to work at AdventHealth Maitland
- Full Time Days (Monday - Friday 8:30am - 5pm)
- Responsible for review and coding of chemotherapy regimen/treatment orders. Review of structured clinical data matching against insurance payor and/or National Comprehensive Cancer Network (NCCN) guidelines.
- Ensuring specified medical terms, diagnosis, medication codes and supporting clinical documentations are met. Utilization review to facilitate the sending of clinical information in support of the authorization to payor or third-party administrators, as assigned.
- Responsible for communicating to service line partners of situations where medical necessity is not met to include review of journal articles, compendia and/or peer review to justify medical necessity approval.
- Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information. Accurately enters required authorization information in AdventHealth systems to include length of authorization, total number of visits, and/or units of medication.
- Responsible for denial notification to clinical counterparts, meeting strict timely notification standards. Completes patient estimates for chemotherapy regimen/treatment plan to include medication units, deductible, coinsurance and out of pocket maximums. Obtains PCP referrals when applicable.
- Meets or exceeds audit accuracy and productivity standard goals determined by Pre-Access leadership, while meeting timeline standards established by leadership for all patient services.
- One (1) year experience in Patient Financial Services, Patient Access, Customer Service or related area (registration, finance, collections, customer service, medical office, or contract management)
- Associate’s Degree and/or higher-level education or completed coursework (Preferred)
- Two (2) years’ experience in Oncology related business operations within
- specialty pharmacy, insurance verification, payor reimbursement guidelines, and/or authorization submission. Familiarity with medical terminology and concepts. Working knowledge with third party insurance administrator’s authorization and clinical care processes. (Preferred)
- Clinically relevant certification such as Medical Assistant, Patient Care Tech or Pharmacy Tech (Preferred)
The Pre-Access Infusion Financial Clearance Specialist, under general supervision, maintains performance standards appropriate to area by obtaining account benefits and/or verifying authorizations are in place for all chemotherapy regimens and treatments, and meeting time line standards established by leadership for all patient services. Meets or exceeds department audit accuracy and productivity standard goal. Uses utmost caution that obtained benefits, authorizations, and/or pre-certifications are accurate according to the actual test, and procedure or registration being performed.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.